First photos of Giffords released since shooting

HOUSTON – Two portraits of a smiling Rep. Gabrielle Giffords gave the nation its closest look yet at the congresswoman's remarkable recovery less than six months after she was shot in the head at point-blank range outside a supermarket.

The pictures posted Sunday on Facebook were the first clear photos of the Arizona congresswoman who rose to national prominence after a gunman opened fire on her in January as she met with constituents in Tucson. Six people were killed and 13 others wounded.

But the images left unanswered many questions about her cognitive abilities and when — or even if — she will be able to resume her job in Congress.

"The image doesn't tell us the inner mental state or the brain itself, how it's functioning," said Jordan Grafman, director of the Traumatic Brain Injury Research Laboratory at the Kessler Foundation Research Center in West Orange, N.J., explaining that many brain-injury patients look good within months of being hurt.

"What's their social skills? Do they have a nuanced sense of humor? Can they participate in activities? All that is what's important," asked Grafman, who has not treated Giffords.

In one of the images, Giffords smiles broadly and looks straight at the camera like a high school student posing for a yearbook. In another, more candid shot, she is grinning alongside her mother. In both, her smile is largely unchanged, though her hair is shorter and darker. The pictures give few indications she has been hurt, let alone shot in the forehead.

Giffords' aides say she could be ready to be released from a rehabilitation center later this month or in early July. The idea was to discourage a "paparazzi-like frenzy" of photography when she attends outpatient therapy in a more public setting, they said.

The congresswoman's staff said the images had not been altered or touched up in any way. But other than saying the pictures were taken May 17 at the Houston rehabilitation hospital where Giffords has been undergoing treatment, her staff offered no further insight into her recovery.

For months, they have closely guarded Giffords and information about her condition. Her doctors, in the absence of permission from the family to speak publicly, remain mum. So the release of the photos attracted intense interest.

Giffords was shot in the left side of the head, the part of the brain that controls speech and communication. Doctors, friends and families have said she can speak, sing some of her favorite songs and engage in some conversation.

Rep. Debbie Wasserman Schultz told NBC's "Meet the Press" she had a "wonderful conversation" Wednesday with Giffords on the phone, and that this time her colleague even initiated some of the topics they discussed.

Since she was wounded, the public's only other glance of Giffords came in grainy images from late April that showed her slowly walking up the steps of a NASA jet that flew her to Cape Canaveral, Fla., to watch her husband, astronaut Mark Kelly, rocket into space.

The launch was delayed, forcing Giffords to make a second trip to Florida in May, when she watched the blastoff from a wheelchair.

Giffords spokesman C.J. Karamargin acknowledged that the congresswoman looks different now than in the photos. Her hair is shorter because her head was shaved ahead of surgery to repair a gap in her skull that had initially been left open to allow her brain to swell. Doctors also fixed what appear to be subtle inequities between her eyes seen in the pictures, he said.

The photos were released to help satisfy "intense interest in the congresswoman's appearance." And they seemed to please the public and her admirers.

Hundreds of people commented under the images, which were posted on countless web sites. More than 3,000 people clicked "like" on Giffords' Facebook page.

Some of the comments also mentioned Jared Lee Loughner, 22, the shooting suspect who has pleaded not guilty to charges stemming from the shooting. He is being held at a Missouri facility where prosecutors hope his competency can be restored after a judge declared him unfit to stand trial.

Others raised questions about the actual extent of Giffords' progress.

"It would be nice to get a truly honest assessment of her internal cognitive experience," wrote Alex Hakkinen, who told the AP he works with brain injury patients at a rehab center in Lawrenceville, N.J.

Hakkinen said Giffords' staff has an obligation to bring her out in public at some point so constituents can assess her abilities, maybe in a "fireside chat" of sorts. Or they should acknowledge that she's incapable of doing so right now, he said.

Chief of Staff Pia Carusone indicated in an interview published Thursday in the Arizona Republic that, despite reports that Giffords is talking and walking, she remains a shadow of her bubbly self. The congresswoman, she said, can verbalize her basic needs, but struggles to string together more complex thoughts.

If her recovery "plateaued" now, Carusone said, Giffords' quality of life would be far less than what she had known before the shooting.

Carusone stopped short of answering the most critical questions: Will Giffords' resume her post in the House of Representatives and will she run for the Senate?

Until the Jan. 8 shooting, some Arizona Democrats viewed Giffords as one of their best hopes for gaining votes in the Senate.

The shooting has created something of a vacuum, with few candidates willing to declare their interest until Giffords' situation is clarified. Carusone has only said that the congresswoman has until May 2012 to decide.

In the short-term, the photos focused attention on Giffords' appearance.

Of the two pictures, one is more clearly posed, that of a smiling Giffords looking directly at the camera. The left side of her head appears slightly distorted and swollen, and a healed scar from a breathing tube can be seen in her neck. A second photo shows Giffords in a more casual light — smiling while sitting alongside her mother, Gloria Giffords, with the hospital's greenery behind them.

The pictures were taken by Tucson photographer P.K. Weis, who said he has known the congresswoman for at least 10 years.

But brain expert Grafman noted the camera is angled toward Giffords' right side, her better half since the bullet struck her on the left.

For some, simply seeing the congresswoman smiling and radiant was encouraging.

Susan Hileman, who survived three gunshot wounds in the rampage, said she spent Sunday morning smiling while looking at photos of Giffords.

"I am delighted and pleasantly surprised," said Hileman, who was holding the hand of 9-year-old shooting victim Christina-Taylor Green when the gunfire erupted. "Look at that smile. How could you not be happy looking at that smile?"

The pictures, Hileman said, gave her hope as she endures her own painful rehabilitation.

"It's a miracle she's alive ... It's going to be a long road, but if anybody is well-positioned to do it, it's Gabby," she said. "She's physically fit. She's smart. She's driven. She's young ... She has all the pieces in place."

Those elements will ultimately help her long-term recovery, experts say. A person's education, intelligence, environment and life experience affect recovery from a brain injury.

"It's striking. She does look great," said Dr. Richard Riggs, chairman of physical medicine and rehabilitation at Cedars-Sinai Medical Center in Los Angeles.

Still, Riggs, who has not been involved in Giffords' treatment but has been tracking her progress, said the months after her release will be critical.

Patients who have suffered traumatic brain injury can become easily disoriented, have trouble prioritizing, suffer memory loss and have difficulty recognizing people. Some struggle to do several tasks at the same time.

Most cognitive recovery occurs in the first six months to a year after an injury, though it becomes less noticeable as time progresses. In the second year, progress sharply drops.

"The picture tells us that physically she's having what would appear to be a strong recovery from that standpoint," Riggs said. "But it does not tell us anything about the cognitive capabilities or where she is on the path of independent living much less going back to a job."

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Myers reported from Phoenix. Associated Press Writer Bob Seavey in Phoenix also contributed to this report.